The first cases of West Nile virus in Washington State this year have been reported in Spokane County.

One man in his 60s remains in the hospital, a second has been released and is recovering at home. A third infection was identified, but was likely acquired outside the state.

Last year, nine cases were reported in Washington, with one death in Benton County.

The disease spreads through mosquito bites. According to the Spokane County Health District, tests for the virus in mosquitoes, birds and horses turned up positive back in August. That’s also when health officials from north Idaho reported the disease in Kootenai County.

Symptoms include headache, fever and discomfort in the neck, muscles and joints, although the majority of cases do not display symptoms.

In Oregon, five cases of West Nile virus have been reported this year.